Exam 1 - HTN

Question 1

Normal BP:

Answer 1

<120 and <80

Question 2

Elevated BP:

Answer 2

120-129 and <80

Question 3

Stage 1 HTN:

Answer 3

130-139 or 80-89

Question 4

Stage 2 HTN:

Answer 4

> 140 or >90

Question 5

Autonomic nervous system can have a dysregulation of what 2 pathways?

Answer 5

Baroreflex and chemoreflex

Question 6

3 pathophysiological factors that can increase BP?

Answer 6

1. Autonomic nervous system
2. RAAS
3. Endogenous vasodilator/vasoconstrictor balance

Question 7

BP goal for preop?

Answer 7

<130/80

Question 8

What are the 4 first line meds to treat BP perioperatively?

Answer 8

1. Thiazide
2. CCBs
3. ACE-I
4. ARBs

Question 9

Preop BP to delay surgery for cardiac evaluation?

Answer 9

SBP >180 or DBP >110

Question 10

Should BBs be continued for day of surgery?

Answer 10

Yes

Question 11

Should ACE-I or ARBS be continued on same day of surgery?

Answer 11

No

Question 12

Should BBs be started on day of surgery?

Answer 12

No

Question 13

What 3 things do preoperative HTN lead to:

Answer 13

1. Increase blood loss
2. MI
3. Cerebrovascular events

Question 14

Do HTN pts have more or less volatile BP preoperatively and intraop hypotension?

Answer 14

More

Question 15

Sympathetic activation during induction of anesthesia increases the BP and HR by how much?

Answer 15

BP: 20-30mmHg
HR: 15-20 BPM

Question 16

In pts with untreated HTN, how much can BP and HR increase by?

Answer 16

BP: 90mmHg
HR: 40BPM

Question 17

What is considered an intraoperative HTN crises?

Answer 17

BP >160/90

SBP >20% of preop value that persists for >15min

Question 18

What 4 things can intraop HTN crises cause?

Answer 18

1. Bleeding (surgical site and intracranial)
2. CNS (HTN, stroke)
3. MI (HF, MI, aortic dissection)
4. Kidney (acute renal dysfunction)

Question 19

Goal of therapy during intraop HTN crises?

Answer 19

Halt vascular damage and reverse pathological process

-NOT normalize BP

Question 20

Pts with chronic HTN auto regulate cerebral blood flow around higher or lower set points?

Answer 20

Higher

Question 21

2 CCB drugs:

Answer 21

Nicardipine

Clevidipine

Question 22

Which CCB drug is better to treat HTN?

Answer 22

Clevidipine

Question 23

3 vasodilators:

Answer 23

Sodium nitroprusside
Nitroglycerin
Hydralazine

Question 24

Is hydralazine a first line agent for most pts?

Answer 24

NO

Question 25

What can sodium nitroprusside lead to with prolong use?

Answer 25

Cyanide toxicity

Question 26

What do you administer to prevent CN toxicity?

Answer 26

Thiosulfate

Question 27

3 adrenergic receptor blockers:

Answer 27

Esmolol Labetalol Phentolamine

Question 28

Which receptor does esmolol block?

Answer 28

Beta 1

Question 29

Which receptor does labetalol block?

Answer 29

Alpha 1 and non selective beta

Question 30

Which receptor does phentolamine block?

Answer 30

Nonselective alpha

Question 31

What type of drug is fenoldopam?

Answer 31

Dopamine 1 receptor selective agonist

Question 32

Does ACE-I have a predictable BP response?

Answer 32

NO

Question 33

What are the 4 preferred drugs for HTN?

Answer 33

1. Clevidipine 2. Esmolol 3. Nicardipine 4. Nitroglycerin

Question 34

What is considered an acute postop HTN? (3)

Answer 34

1. SBP >180 2. >20% increase in SBP 3. DBP >110

Question 35

3 common causes for acute postop HTN?

Answer 35

1. Failure to take chronic med presurgery 2. Hypervolemia from periop fluids 3. Overactive sympathetic system (hypoxia, anxiety, pain)

Question 36

What short acting IV drugs should be used to treat acute postop HTN? (3)

Answer 36

1. Esmolol or labetalol 2. Clevidipine or nicardipine 3. ACE-I or hydralazine

Question 37

What 3 steps are taken to treat acute postop HTN?

Answer 37

1. Address what is causing the HTN first 2. Titrate short acting IV drugs 3. Resume oral antiHTN